Cyanotic congenital heart disease (CCHD) causes chronic hypoxia in several organs, especially kidneys. The association between CCHD and nephropathy has been known although the mechanism is not yet completely understood. This study was aimed to investigate the association between CCHD and the incidence of nephropathy in children.
This case-control study was conducted at the Pediatric Outpatient Installation of the Integrated Heart Service Center (IHSC) and Children's Inpatient Room, Dr. Soetomo General Hospital Surabaya from January to May 2021. The inclusion criteria included children with CCHD and normal children aged 1-18 years who visited IHSC and Pediatric Clinic. Informed consent was signed by the parents. Demographic data, proteinuria, and hematuria were analyzed to find the association with the incidence of CCHD in children.
Eighty-five participants participated in the study, of which seven were excluded, leaving 78 eligible participants. Forty-four CCHD patients and 34 control patients had a difference in oxygen saturation (67.70 ± 11.21 to 94.94 ± 0.98%). Sixty-four percent of the participants were diagnosed with tetralogy of Fallot (TOF), while 29.5% were diagnosed with double outlet right ventricle (DORV). There was a significant association between CCHD with proteinuria and hematuria (p = 0.001, r = 0.481; p = 0.001, r = 0.375). Significant associations was also found in proteinuria and hematuria with CCHD with a diagnosis of DORV and TOF (p = 0.014, p = 0.002).
As a conclusion, a significant association was found between CCHD with the incidence of proteinuria and hematuria. Nephropathy screening is needed in patients suffering from CCHD to detect renal damage.
Background: Heat-shock protein 70 (HSP70) is important in host responses to various stresses. This study analyzed the correlation between preoperative serum concentrations of HPS70 and postoperative morbidity in patients with esophageal cancer.
Materials and Methods: Serum samples were obtained preoperatively from 31 patients with esophageal squamous cell carcinoma. Serum HSP70 concentrations were measured by enzyme-linked immunosorbent assay and the relationships between serum HSP70 level and postoperative morbidities were analyzed.
Results: The mean concentration of serum HSP70 was 9.71 ng/ml. When patients were dichotomized relative to this cutoff, no significant relationships between perioperative inflammatory markers and serum HSP70 level were observed. The incidence of postoperative complications was significantly lower in patients with HSP70 ≥9.71 ng/ml (p=0.0281).
Conclusion: Preoperative serum level of HSP70 was significantly correlated with postoperative morbidities in patients with esophageal cancer. Therefore, enhancing the HSP70 level prior to invasive surgery could be a feasible strategy to prevent morbidity.
The neurotransmitters and neuromodulators implicated in the processing of sensory and nociceptive information, γ-aminobutyric acid (GABA) is of importance in the spinal dorsal horn (SDH) neurons. Decrease in GABAergic inhibitory synaptic transmission plays an important role in mechanisms of neuropathic pain (NeP). We hypothesized that functional and structural changes in GABA receptors of SDH may occur after peripheral injury (PNI). In the present study, using whole-cell patch-clamp recording, we characterized the GABA receptor-mediated currents (IGABA) and GABA receptor-mediated inhibitory postsynaptic currents (GABA-IPSCs) recorded from SDH neurons, and investigated the effects of the sciatic nerve ligation on these currents in the glutamate decarboxylase (GAD) 67 green fluorescent protein (GAD67-GFP) knock-in mice. Furthermore, using the quantitative real-time PCR analysis, we evaluated alterations of the expression level of the GABA receptor subunits by the sciatic nerve ligation. We observed changes in IGABA and GABA-IPSCs in both GFP-negative and positive neurons, and alterations of the expression level of the GABAA receptor subunits, in SDH after the sciatic nerve ligation. Our results suggest that influences on the function and structure of GABAergic neuron in SDH by PNI may play an important role in the mechanism of NeP.
In patients with chronic heart failure (CHF), blood is redistributed to the major organs and blood perfusion of peripheral tissues decreases. Consequently, the skin temperature decreases, and patients experience a peripheral cold sensation (PCS). Blood reallocation involves autonomic nervous system control. In other words, a decrease in skin temperature and variation in autonomic nervous activity may be predictors of CHF severity. Forty-five patients with CHF were identified by New York Heart Association (NYHA) functional classification and divided into NYHA class I and NYHA class II-III groups. The temperature of the eardrum, toe, and skin were measured and the autonomic nervous activity was estimated by heart rate variability. We compared the results between the NYHA groups. The temperature of the left dorsum pedis and right pollex pedis were significantly lower in the NYHA class II-III group than in the NYHA I group. The difference in temperature between the eardrum and the left dorsum pedis and that between eardrum and right pollex pedis was significantly greater in the NYHA class II-III group than in the NYHA I group. However, there was no significant intergroup difference in autonomic nervous activity was noted. Body surface versus deep body temperature in patients with CHF were significantly lower in those with NYHA class II-III versus NYHA class I disease. Thus, PCS might be associated with CHF severity.
We report about a patient with an extremely rare long-segment Barrett's esophagus (LSBE) who developed extensive superficial adenocarcinoma and underwent radical (R0) resection based on an accurate preoperative diagnosis of tumor extent. A 68-year-old man with no subjective symptoms and no noteworthy medical history was diagnosed with adenocarcinoma after a biopsy of a protruding lesion in the lower esophagus. Narrow-band imaging (NBI) magnification endoscopy revealed that the protruded lesion was within the LSBE, and a flatly extended superficial esophageal adenocarcinoma (SEAC) was observed proximal to the protruded lesion. After confirming the extent of the tumorous lesion via endoscopic biopsy, sub-circumferential endoscopic submucosal dissection (ESD) was performed for the extensive tumor, which resulted in a histological R0 resection. Prophylactic steroid therapy was performed to prevent refractory post-ESD stenosis. There was no residual tumor or recurrence of the cancer, and the patient's postoperative course was favorable. Preoperative diagnosis of tumor extent using NBI magnification endoscopy may therefore be useful for characterizing SEAC occurring in the LSBE, given that detecting the presence and determining the extent of these tumors is normally difficult. Prophylactic therapy with local steroid injection can prevent refractory stenosis after quite extensive ESDs for SEACs in the LSBE.
Retropharyngeal hematoma is an uncommon but potentially life-threatening condition because of the risk of upper airway obstruction. Herein, we described a case of retropharyngeal hematoma after a minor trauma that caused the neck to be hyperextended in a patient taking clopidogrel. A woman in her seventies fell from a standing height and hit her face causing a hyperextension injury to her neck. She was diagnosed with airway obstruction, and orotracheal intubation was performed. Contrast-enhanced computed tomography revealed a retropharyngeal hematoma. She was managed conservatively, and a tracheostomy was performed six days after the injury. Repeated computed tomography scans showed shrinkage of the hematoma, hence, the tracheostomy tube was removed. She was discharged 27 days after the injury. This case report indicates that health care providers should be aware of the risk of airway obstruction after a minor trauma that may cause the neck to be hyperextended. Because patients with predisposing factors of bleeding and hyperextension injury on their neck are more likely to have a retropharyngeal hematoma, assessment using computed tomography is recommended.
It is difficult for clinicians to predict the existence of undiagnosed asymptomatic congenital malformation, particularly in the emergency department (ED) setting. While it is sometimes directly associated with disease prevalence and clinical manifestation, we could overlook this significant background information without awareness. When an elderly patient with undiscovered malformation came to ED, the situation might become more challenging because their presentations are often ambiguous or atypical compared to younger patients. This leads to diagnostic delay due to some cognitive biases. In such situations, analytical thinking, especially consideration from the anatomical or physiological perspectives, should be warranted as well as intuitive thinking based on reconsidering the patient's sensitivity of specific diseases. Herein, we report a good example: delayed diagnosis of acute pyelonephritis in a horseshoe kidney in an 83-year-old woman.
The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemorrhagic shock due to truncal or junctional trauma has recently been reported. While the usefulness of REBOA in trauma patients has been described in the literature, its efficacy on survival and indication remains unclear. For bleeding control of the truncal or junctional trauma below the diaphragm, REBOA is used, and it increases the blood flow to the brain and heart. These are well-known benefits of REBOA; however, there are few discussions about the benefit of REBOA in maintaining a bloodless operative field and facilitating hemostasis. We encountered a case of hemorrhagic shock due to pancreatic head injury, which required REBOA for catastrophic bleeding control, resulting in a good operation field and facilitating hemostasis. The use of REBOA to maintain a bloodless operation field in hemodynamically unstable patients who suffer truncal or junctional trauma and/or the use of REBOA for hemostasis, which is difficult to deal with due to continuous bleeding, may be a good indication.
A 61-year-old female complained of nasal stuffiness and bleeding, and she was found to have multiple fibroepithelial polyps in the inferior turbinate. Reports regarding polyps in the nasal cavity mucosa are very rare. We treated the patient by excising the polyps and using a microdebrider to expose the bone. More than one year later there had been no recurrence of the polyps. Reports of cases of polyp formation in the tracheal mucosa have pointed out the histological possibility of neoplasms and the risk of recurrence. Thus, long-term observation of this patient will be necessary.
Iatrogenic Cushing syndrome is a well-known adverse reaction of steroids, but there are few reports of this condition caused by topical agents. Although systemic side effects from topical steroids are rare, lack of physician awareness and patient guidance can lead to a risk of adverse reaction of steroids. A 12-year-old girl had been treated with betamethasone butyrate propionate as atopic dermatitis from age 6. However, her family doctor continued to prescribe without explaining how to use and the risks of side effects. As a result of continuing to apply 15 grams of it all over her body every week, except in summer when skin symptoms were mild, she developed Cushing syndrome and was referred to our hospital after short stature was reviled at school physical examination. Although MRI scan indicated possible anterior pituitary suppression, there were no suppressive findings in the hormone loading test. With appropriate topical steroids, Cushing symptoms have generally improved, and the decline in the growth rate of her height has stopped. Thus, topical corticosteroids can cause systemic side effects in children. We should avoid inappropriate topical steroids use and properly instruct patients and their families about the use of the drugs and the side effects of treatment.
The patient was a 68-year-old woman who was hospitalized for SARS-CoV-2 pneumonia while receiving chemotherapy for B-cell lymphoma. She experienced repeated episodes of pneumonia that temporarily went into remission with steroid and remdesivir and but then relapsed or worsened. However, no particular subjective symptoms or deterioration on imaging was observed by an antibody cocktail treatment after Day 119. SARS-CoV-2 IgM and IgG antibody levels were below the limit of detection on Day 180 but she tested positive for SARS-CoV-2 by PCR on Day 151. In the case of this patient who had persistent SARS-CoV-2 infection due to being immunocompromised, treatment temporarily stalled the worsening of symptoms. However, new treatments for such patients should be established soon.